Assessment of Rates of Suicide Risk Screening and Prevalence of Positive Screening Results Among US Veterans After Implementation of the Veterans Affairs Suicide Risk Identification Strategy

Abstract

IMPORTANCE In 2018, the Veterans Health Administration (VHA) implemented the Veterans Affairs (VA) Suicide Risk Identification Strategy to improve the identification and management of suicide risk among veterans receiving VHA care. OBJECTIVES To examine the prevalence of positive suicide screening results among veterans in ambulatory care and emergency departments (EDs) or urgent care clinics (UCCs) and to compare acuity of suicide risk among patients screened in these settings.

Thirty-day suicidal thoughts and behaviours in the Spanish adult general population during the first wave of the Spain COVID-19 pandemic

“…Above all, the results urge policy-makers to increase access to adequate mental healthcare in Spain, even during this time of healthcare system overload. The fact that nearly one out of 20 Spanish adults screened positive for STB points to the need for multi-stage routine suicide risk screening programmes in healthcare systems (Bahraini et al ., 2020 ), and for augmenting the availability of crisis response helplines, safety planning and evidence-based treatments for STB (Gunnell et al ., 2020 ; Moutier, 2020 ; Wasserman et al ., 2020 ). In addition, one out of four Spanish adults screened positive for current mental disorders and roughly 58% of STB is potentially attributable to these disorders.…”

Adapting Caring Contacts for Veterans in a Department of Veterans Affairs Emergency Department: Results From a Type 2 Hybrid Effectiveness-Implementation Pilot Study

“…Who receives CC and how to identify? The advisory board selected the VA-required screen for suicide risk in ED triage as the method for identifying veterans to receive CC (33). Item 9 from the Patient Health Questionnaire-9 (PHQ-9) (34) was initially used as the primary screener; VA later changed this to the Columbia-Suicide Severity Rate Scale Screener (C-SSRS) (35).…”

Veterans Health Administration staff experiences with suicidal ideation screening and risk assessment in the context of COVID-19

“…At the time of the interviews, the Risk ID process consisted of three stages: question 9 of the Patient Health Questionnaire-9 (PHQ-9), the Columbia Suicide Severity Rating Scale Screener (C-SSRS) [9], and VA Comprehensive Suicide Risk Evaluation (CSRE), a structured clinical assessment tool developed internally by the VA which inquires about factors critical to suicide risk [4]. Patients who screened positive on the PHQ-9 question (response of 'yes' to the question "thoughts that you would be better off dead or of hurting yourself in some way") were screened using the C-SSRS; a positive C-SSRS (defined as yes response to items 3, 4, 5, or 6b.)…”

“…The joint VA-Department of Defense Clinical Practice Guidelines for the Assessment and Management of Patients at Risk for Suicide [3], published in 2019, recommends universal screening using a validated screening tool to identify individuals at risk and comprehensive follow-up assessment of individuals identified as being at risk. In accordance with these guidelines, the VHA recently implemented a multi-stage suicide risk assessment protocol across primary care, emergency department, and specialty mental health settings called VA Suicide Risk Identification Strategy, or "Risk ID" [4]. In early 2020, we initiated a study to understand Veteran and staff perceptions of Risk ID and how screening processes and perceptions of screening may impact subsequent care.…”